All patients will receive an ablativ e dose of 30mCi of radioactive iodine (RAI) within 4 months of surgery. If you are new to coding ENT procedures, the thyroidectomy section of the CPT manual can be daunting. Central Compartment Neck Dissection With Thyroidectomy Youll select from the 41120-41155 range when reporting this procedure. official website and that any information you provide is encrypted CPT 60252 versus 60254 | Medical Billing and Coding Forum - AAPC The Sponsor can temporarily or permanently discontinue an investigator for participation in the clinical trial at any time. Glossectomy is the surgical removal of all or part of the tongue, usually due to cancer. 2013;154(6):114855 discussion 54-5. Cite this article. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients. This study is entirely financed by a grant from the French National Cancer Institute (InCA, PHRC-K15-182) (annexes 8 and 8 bis). If we look at our first question of whether the entire thyroid was removed or only a portion, we can see that the entire thyroid was removed (see the words highlighted in green indicating that both the right and left lobes were mobilized and the entire thyroid gland was removed). Leenhardt L, Erdogan MF, Hegedus L, Mandel SJ, Paschke R, Rago T, et al. Thyroid nodule measuring 1140 mm on ultrasound (cT1bT2), AND with fine-needle aspiration biopsy (FNAB) cytology in favor of papillary thyroid carcinoma (Type 6 according to the Bethesda classification (Appendix 2), OR with FNAB cytology suspicious for malignancy (Type 5 according to the Bethesda classification). The pharmacovigilance unit at Gustave Roussy will issue once a year throughout the clinical trial, or on request, the annual safety report (ASR) of the study. Follow-up. Moving on to question #3, we have no mention that any portion of the thyroid was removed during a prior surgery so this question is not applicable in this case. The primary outcome is to compare the rate of excellent response at 1 year after surgery between the groups, as defined by an unstimulated serum thyroglobulin (Tg) level 0.2 ng/mL with no anti-Tg antibodies, an normal neck ultrasound and no ectopic uptake on the post-RAI scintiscan. Identifying members of his/her team participating in the trial and defining their responsibilities. Lymph Node Removal If your tumor has spread or is likely to spread to your lymph nodes, your surgeon will remove the lymph nodes in your neck during your thyroid surgery. In a similar prospective multicenter trial, 90.2% of the low-risk patients, including patients T1-T3 N0-N1 with or without central compartment neck dissection, were in complete biological remission at 1 year [42]. You should not report a separate code. Group 2 (experimental group): total thyroidectomy alone without neck dissection. Leboulleux S, Bournaud C, Chougnet CN, Zerdoud S, Al Ghuzlan A, Catargi B, et al. Surgery is performed under general anesthesia. While code 38700 is properly used to code the very limited SHND involving level I only, all other SNDs are reported with CPT code 38724, Cervical lymphadenectomy . A patient will be in remission if the requirements are met at 1 year following randomization. Major deviation is defined as any conditions, practices, or processes that might adversely affect the rights, safety, or well-being of the subjects and/or the quality and integrity of data. Surgical approach to level VI in papillary thyroid carcinoma: an overview. YG, XC, SB, AL-C, PV, EI, SZ, JS, MZ, LLM, OS, AK, PK, PR, LB, SG, EH: Trial co-investigators. CAS Liang J, Li Z, Fang F, Yu T, Li S. Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. See our privacy policy. The data collected through the eCRF will be the source data for the analysis. Because CPT doesnt include a code for the thyroidectomy with modified radical neck dissection, you should report 60240 Thyroidectomy, total or completewith 38724 Cervical lymphadenectomy [modified radical neck dissection]. https://doi.org/10.1186/s13063-023-07294-0, https://afce-chirurgie-endocrinienne.com/wp-content/uploads/2019/11/afce_concensus_cancerthyroide0907.pdf, https://www.santepubliquefrance.fr/maladies-et-traumatismes/cancers/cancer-du-sein/documents/rapport-synthese/estimations-nationales-de-l-incidence-et-de-la-mortalite-par-cancer-en-france-metropolitaine-entre-1990-et-2018-volume-1-tumeurs-solides-etud, https://doi.org/10.1245/s10434-010-1137-6, https://sante.gouv.fr/IMG/pdf/proms_eq5d5l_generique.pdf, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. What is the CPT code for neck exploration in addition to this? Prospective randomized open phase III non-inferiority trial in patients with cT1bT2N0 [50] papillary thyroid carcinoma comparing: total thyroidectomy alone (experimental group) versus total thyroidectomy with prophylactic neck dissection (PND) (reference group). Reasons may include, but are not limited to, the following: Serious breach is defined as any conditions, practices, or processes that adversely affect the rights, safety, or well-being of the subjects and/or the quality and integrity of data. CPTxae Code 60240 in section: Excision Procedures on the Thyroid Gland. Borget I, Bonastre J, Catargi B, Deandreis D, Zerdoud S, Rusu D, et al. CPT 38724 is for cervical lymphadenectomy (modified radical neck dissection), and because right selective neck and central compartment neck dissection falls under the radical part of the procedure rather than the complete removal lymphadenectomy, CPT 38724 is the appropriate code for this situation. ICD-10-CM is a billable/specific code that can be used for reimbursement purposes to indicate a diagnosis. Clinicopathological pattern of lymph node recurrence of papillary thyroid cancer. In this report, we have used the SPIRIT reporting guidelines [54]. Therefore, no data transfer will be needed. Br J Surg. Data will be analyzed according to the scoring manual of each questionnaire. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Feedback: Rationale: The removal of all of the lymph nodes of the neck during a thyroidectomy is considered a radical neck dissection. Privacy Policy | Terms & Conditions | Contact Us. What is the CPT code for a complete thyroidectomy? Initial Experience of Endoscopic Thyroidectomy Using Bilateral Axillary Breast and Transoral Vestibular Approach in Georgia. PND may also involve greater morbidity in terms of transient hypoparathyroidism [9]. CPTxae 60200, Under Excision Procedures on the Thyroid Gland The Current Procedural Terminology (CPTxae) code 60200 as maintained by American Medical Association, is a medical procedural code under the range Excision Procedures on the Thyroid Gland. Or, would 60260, Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid and a code for the central lymph node dissection (38510, 38520 or 38999) both be reported? Group 1 (reference group): total thyroidectomy with bilateral prophylactic central compartment (level VI) neck dissection. From the jawbone to the collarbone, all of the tissue on the side of the neck has been removed. It plays a significant role in the metabolism of the body cells through the secretion of Thyroxine (T4) and triiodothyronine (T3) (hormones)into the blood. 60270 Thyroidectomy, including substernal thyroid; sternal split or transthoracic approachThe provider removes the thyroid gland, including the extension of the gland below the breastbone. Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, et al. Consensus review and statement regarding the anatomy, Stack, Jr. BC, Ferris, RL, Goldenberg D, Haymart M, et al. Adaptation canadienne-franaise de la forme rvise du State-Trait Anxiety Inventory de Spielberger [A French-Canadian adaptation of the revised version of Spielbergers State-Trait Anxiety Inventory. The patient was then prepped (including 1010 drape) and positioned for a central neck dissection . The platysmas and skin are closed. Medicina | Free Full-Text | A Review of the Significance in Measuring Results will be sent to the competent authority and to the Ethic Committee. DMH: Principal Investigator, study conception and oversight. Tisell LE, Nilsson B, Mlne J, et al. Thyroid cancer is the most common endocrine malignancy with an increasing incidence over the past few years. Quality of life and cost-effectiveness assessment of radioiodine ablation strategies in patients with thyroid cancer: results from the randomized phase III ESTIMABL trial. If non-inferiority is demonstrated with this high-level evidence, prophylactic neck dissection will have been shown to not be necessary in clinically low-risk papillary thyroid carcinoma. Inclusion and non-inclusion criteria and patient consent, Anxiety (State-Trait Anxiety Inventory) (Annex 4) [49], Subjective dysphonia and dysphagia (measured via the Voice Handicap Index (ANNEX 5) [45] and SWAL-QOL) (Annex 6)[46], Group 1 (reference group): total thyroidectomy with bilateral prophylactic central compartment neck dissection. These previous studies all show high rates of excellent response. Patients will be evaluated at 8 +/2 months post-iodine (814 months postoperatively or 1 year) then yearly with neck ultrasound, unstimulated ultrasensitive thyroglobulin (usTg/LT4), and anti-Tg antibodies. Any SAE which occurs or comes to the attention of the investigator at any time during the study since consent is given and within 30 days after the last study procedure, independent of the circumstances or suspected cause, must be reported immediately, within 24 h of knowledge (at latest on the next working day) by fax via a SAE report form to the Pharmacovigilance Unit at IGR. Report 38700 only when the surgeon removes only the nodes above the thyroid. Thyroidectomy procedures involve surgical removal of all or part of the thyroid gland. Saint-Maurice: Sant Publique France; 2019. Level VI neck dissection and central neck dissection are interchangeable terms used to describe surgical excision of all lymph nodes from the hyoid bone to the carotid arteries sternal notch, but the superior mediastinal lymph nodes added in compartment VII should be included in the central neck. J Clin Endocrinol Metab. Methods: %PDF-1.7 Finally, the thyroid gland was removed in its entirety and sent to pathology. Centers in France and outside of France may be added as investigators, subjected to approval of an amendment to the study by the national authorities (National Agency for Drug Safety, Agence Nationale de la Scurit du Mdicament et des Produits de Sant, ANSM) and the French nationa research ethics committee (Comit de Protection des Personnes, CPP). Detection of central and lateral neck nodal metastasis preoperatively with clinical examination and cervical ultrasound is important in determining the appropriate initial surgical management. Central neck lymph node dissection plays an important role in the appropriate treatment of papillary thyroid cancer at initial presentation and in cases of recurrent disease. in Thyroid 28(7):825-829, 2018; Le et al. Lets look at a couple of examples. Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma?. ), is considered confidential and will be kept in a safe place. This is a standard treatment recognized by the French Society of Otolaryngology Head and Neck Surgery [15]. Congratulations to the newest AMCI CPCExam Passers. Moving on to question #3, we have no mention of removal of a portion of the thyroid from a prior surgery so this question is not applicable in this case. The opponents of systematic PND have emphasized that the prognostic role of occult metastases has not been demonstrated and that radioactive iodine is effective in treating micrometastases [27, 28]. 2013 Jul;20(7):2261-5. doi: 10.1245/s10434-012-2833-1. PubMed Background and Objectives: Recently, the single-port (SP) robotic system was introduced for minimally invasive operative techniques. If 5% secondary exclusion (final histopathology not differentiated thyroid cancer): 628 patients are required for randomization. Coding tip: When coding thyroidectomy cases, it may help to picture the thyroid as a butterfly with each lobe representing a wing and the isthmus representing the body of the butterfly. Bethesda, MD 20894, Web Policies Prospective randomized open multicenter phase III trial including patients with 1140-mm papillary thyroid carcinoma (Bethesda VI) or suspicious cytology (Bethesda V) confirmed malignant on intra-operative frozen section analysis, with no suspicious lymph nodes on a specialized preoperative ultrasound examination.
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